A surgery rotation.
PMH:
- cervical CA, cord compression symptoms
- generalised discomfort over four limbs
- otherwise neurologically normal
PE: grossly normal. Left eye ?numbness claims to have fasciculation, which is a bad omen in Chinese folktale. Not much findings with CN nerve.
What can you do as a HO?
I did not assume cord compression. Even though that did not seem likely, I still ordered a CT brain, with no changes. It was very diffuse involvement. I worried metabolic / electrolytes problems. So I ordered.
Calcium came back ~ 1.05. It was the lowest I had seen.
Mx would be calcium gluconate injection followed by infusion + hypocalcemia workup. Retrospectively that left eye was probably Chvostek’s sign. ?if I was observant enough to perform the Trousseau’s sign / ECG for long QT, but bloods would do the job anyways.